Dynamic prediction of the risk of recurrence in patients over 60 years of age with differentiated thyroid carcinoma

Morosán, Yanina Jimena; Parisi, Carina; Urrutia, María Agustina; Rosmarin, Melanie; Schnitman, Marta; Serrano, Leonardo; Luciani, Wilfrido; Faingold, Cristina; Pitoia, Fabián; Brenta, Gabriela

doi:10.1590/2359-3997000000146

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Original Articles • Arch. Endocrinol. Metab. 60 (4) • Aug 2016 • https://doi.org/10.1590/2359-3997000000146 copy

Dynamic prediction of the risk of recurrence in patients over 60 years of age with differentiated thyroid carcinoma

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

The reclassification of the risk according to the response to the initial treatment makes the treatment of differentiated thyroid cancer (DTC) vary in each individual. As the influence of age on this diagnostic strategy is unknown, we have decided to assess it in adults who are over 60 years of age.

Subjects and methods

Ninety patients with DTC above 60 years old were enrolled, with total thyroidectomy plus radioiodine ablation, negative anti-thyroglobulin antibodies, follow-up ≥ 2 years and with clinical and pathological information to classify the risk of recurrence according to ATA (American Thyroid Association) and reclassify based on the response to initial therapy according to MSKCC (Memorial Sloan Kettering Cancer Center). The structural persistence at the end of the follow-up was the gold standard of our analysis.

Results

The structural persistence in ATA low, intermediate and high risk categories was 0, 38, and 100%, respectively. In the intermediate group, none of those with an excellent response to the initial treatment showed structural persistence, whereas 39% of those with an incomplete/indeterminate response showed structural persistence (p < 0.01).

Conclusions

The re-stratification according to the response to the initial treatment in patients over 60 years of age with an ATA intermediate risk of recurrence allowed for the distinction of disease-free patients at the end of the follow-up from those with structural persistence and a worse clinical progression.

Thyroid cancer; elderly; risk re-stratification; recurrence; staging

Low risk (all required)	Intermediate risk (any of the following)	High risk (any of the following)
Classic papillary carcinoma (including follicular variant)	Cervical lymph nodes metastases	Gross extrathyroidal extension
Confined to thyroid	Microscopic extrathyroidal extension	Tumour incomplete resection
No vascular invasion	Aggressive histology (insular, tall cell, columnar, diffuse sclerosing, follicular carcinoma)	Distant metastasis
No I131 uptake outside the thyroid bed on the post treatment scan, if done	Vascular invasion	Inappropriate increase of thyroglobulin

Excellent response	Indeterminate response (any of the following)	Incomplete response (any of the following)
Stimulated and suppressed thyroglobulin < 1 ng/mL	Suppressed thyroglobulin < 1 ng/mL and stimulated thyroglobulin ≥ 1 < 10 ng/mL	Suppressed thyroglobulin ≥ 1 ng/mL
Negative neck ultrasound	Non-specific findings in neck ultrasound or stable subcentimeter nodes	Stimulated thyroglobulin ≥ 10 ng/mL
		Rising Tg values
With no other evidence of disease	Non-specific findings in other imaging studies (CT, NMR, nuclear medicine)	Structural persistence of disease

		N = 90
Age at diagnosis (years)
Median (range)	65 (62-82)
Gender
Female	86%	77
Male	14%	13
Histology
Papillary	90%	81
Classic papillary	77%	62
Microcarcinoma	2%	2
Papillary tall cell variant	5%	4
Papillary oncocytic variant	1%	1
Papillary follicular variant	15%	12
Follicular	10%	9
Follicular	67%	6
Follicular oncocytic variant	11%	1
Follicular Hurthle cell variant	22%	2
131I activity for ablation (mCi)
Mean ± SD	118 ± 41.2
Median	100 mCi
AJCC stage
I	48%	43
II	12%	11
III	27%	24
IVa	12%	11
IVb	0%	0
IVc	1%	1
ATA initial risk classification
Low	47%	42
Intermediate	43%	39
High	10%	9
Response to therapy (second year)
Excellent	50%	45
Indeterminate	28%	25
Incomplete	22%	20
Follow-up duration (years)
Mean ± SD	5.36 ± 4.3
Median	4
Range	2-13
Status at final follow-up		n:90
No evidence of disease	64%	58
Structural persistent/recurrent disease	18%	16
Biochemical persistent/recurrent disease	18%	16
Vital status		n:90
Death of disease	1%	1
Death of other causes	5%	5

Patient	Age at diagnosis (years)	Sex	Pathological characteristics	I131 (mCi) doses	AJCC stage	Response to initial treatment	Years of follow-up
1	70	F	Papillary with LN mets	150	III	Incomplete	4
2	62	F	Papillary with LN mets	100	III	Indeterminate	4
3	79	F	Papillary with LN mets	150	III	Incomplete	3
4	66	F	Papillary with tall cell	150	IVc	Incomplete	7
5	73	F	Papillary classic variant with LN mets	100	III	Incomplete	6
6	71	M	Papillary classic variant (5 cm) with LN mets	150	III	Incomplete	8
7	66	F	Papillary classic variant with LN mets	150	III	Incomplete	4
8	69	F	Papillary tall cell	100	II	Incomplete	5

Response to therapy (second year) (n = 90)	NED	Structural persistent disease	Biochemical persistent disease
Excellent (n = 45)	44 (98%)	0 (0%)	1 (2%)
Indeterminate (n = 25)	14 (56%)	3 (12%)	8 (32%)
Incomplete (n = 20)	0 (0%)	13 (65%)	7 (35%)

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[1] Correspondence to: Gabriela Brenta. Department of Endocrinologyand Metabolism, César Milstein Hospital. La Rioja, 951. 1221 – Buenos Aires, Argentina. gbrenta@gmail.com